There are many women in mid-life who believe this is just a normal part of the ageing process.
But that isn't necessarily so. And the lack of interest in a healthy sex life can be addressed.
Women are twice as likely as men to experience low libido.
'They usually say that they are 'too old', 'too tired' or 'have no more drive',' revealed Dr Christopher Chong, a consultant obstetrician and gynaecologist at Gleneagles Medical Centre.
Professor Peter Lim, the medical director of the urology centre at Gleneagles Hospital, estimates that the condition affects 50 per cent of all women ranging in age from 28 to 60 years.
Why women say 'no'
Sex is one of the simple pleasures in life. But doctors say about 50 per cent of women from ages 28 to 60 do not derive pleasure from it.
Dr Christopher Chong, a consultant obstetrician and gynaecologist at Gleneagles Medical Centre said stress and pressure from work, or life in general, is probably the most common complaint, especially for the younger group.
'The stress is mainly from working and over-working. It is not uncommon for my patients to reveal that they have sex at most once a month,' he said.
Other reasons for not getting it on, or not wanting to, include:
» Fear of intercourse 'If the first time proves to be extremely painful and traumatic, phobia of intercourse may result. Fear of pregnancy and infection may also result in low sex drive,' Dr Chong said.
» Tight pelvic bone and vagina While there is not much that can be done about bones, doctors say a tight vagina can be treated easily with surgery.
Suffering from endometriosis, a gynaecologic disorder
This is when tissue from the lining of the womb grows in the ovary. It is associated with painful periods, painful intercourse, heavy periods and sub-fertility.
» Vaginal infection If left untreated, it may result in lower abdominal pain and painful sex.
» Little or no sex after menopause There are many reasons for this. Common ones are feelings of being 'old and tired'.
'Menopause is associated with loss of the hormone oestrogen. This results in vaginal dryness, the clitoris losing its protective covering, loss of tissue elasticity and the thinning of the vaginal lining.
'There is also a decrease in sexual responses and decreased libido. All these will lead to painful sex,' Dr Chong said.
The main reasons for this drought among younger women are a loss of interest, divorce or widowhood, surgery such as a hysterectomy, childbirth, relationship problems and work-related stress.
Yet, it is still not a subject that most women feel comfortable discussing - whether among themselves or with their partners.
And although Singapore doctors say they see many women with hypoactive sexual desire disorder - or low sex drive - there are still no national statistics showing how many women specifically suffer from it.
A check with both the Health Ministry and the Health Promotion Board drew blanks in this area.
Apart from worldwide surveys conducted by condom manufacturer Durex, the most recent study was in 2004 by Professor Goh Hng Hang of the department of obstetrics and gynaecology at the National University of Singapore.
The study, involving 307 men and 774 women between the ages of 30 and 70, showed about a quarter of respondents were sexually inactive.
But despite the lack of statistics, low sexual libido in women is starting to gain more attention.
Associate Professor Ganesh Adaikan, a clinical sexologist with the department of obstetrics and gynaecology at the National University Hospital (NUH), said that women rarely come forward with complaints of loss of desire.
Both Prof Ganesh and Prof Lim agree that this may be due to the lack of awareness and knowledge about 'their own sexual frequency and measures for normal or abnormal levels', said Prof Ganesh.
Prof Lim surmised: 'It could also be due to culture. In the majority of cases in Asia, women are passive when it comes to sexual intercourse.'
Prof Ganesh said most times, women come with their partners for therapy as couples.
'Their lack of desire may also come to light during the treatment for fertility-related issues and problems of non-consummation,' he said.
Dr Rosemary Basson, an expert on female sexual dysfunction in the United States, believes that women in long-term relationships tend not to have the same 'spontaneous sexual neediness' as men do.
'But they can be aroused or triggered,' she said.
Blame it on falling male hormones
Recent studies on female sexual dysfunction have moved away from the psycho-social aspect and begun focusing on the biology of the problem.
There have been clinical trials in Europe and the US that have found a possible correlation between women with low libido and decreased testosterone levels.
Testosterone is a male hormone that is also present in women but in low concentrations. It affects muscle mass.
Dr Ann Tan, a consultant obstetrician and gynaecologist at Mount Elizabeth Medical Centre, said testosterone deficiency can result in abnormal development of the genitals, even in women who have been using supplemental oestrogen.
In men, the hormones are made primarily in the Leydig cells of the testicles. In women, half of the testosterone is produced in the ovary, while the other half is from the adrenal glands, located on top of the kidneys.
Therefore, damage to the ovaries or adrenal glands will result in a deficiency.
Hormone treatment: swallow or spread?
But there are products being developed to deliver the missing hormone to women with low levels of testosterone and a lower sex drive.
This would help to significantly increase sexual desire, but there is no consensus among doctors about the benefits and risks of testosterone therapy for women with low libido.
Oral treatment, injections or implants of testosterone are available for selected women patients.
Although testosterone therapy may be beneficial for some women who have had their ovaries surgically removed or have significant loss of libido, it is not the answer for someone with a poor relationship, or who is depressed.
According to a study by the Women's Health Programme at Monash University in Australia, testosterone should not be given to post-menopausal women unless they receive oestrogen therapy simultaneously.
Also, when such therapy is administered, the patient must go for regular checks on her blood testosterone levels to prevent overdosing or the development of masculine side effects.
Recently, Biosante Pharmaceuticals started its Phase III clinical safety trial of LibiGel - a testosterone-laden ointment intended to boost low libido among women - at the University of Virginia.
The drug has promised to do for women what Viagra has done for men.
However, both Dr Chong and Dr Tan cautioned against using testosterone therapy without consulting a doctor first.
'Topical testosterone, for instance, could result in high blood levels of the hormones above physiological range. This is because testosterone is very well absorbed and has the potential for local overstimulation and gradual clitorial enlargement,' Dr Tan explained. She said, though, that the conditions are reversible if the woman stops using the topical cream.
Dr Tan said doctors can prescribe bio-identical testosterone, made by converting a substance found in wild yam or soy into testosterone through a series of chemical changes.
'These are exactly similar in function and molecular structure to our naturally occurring hormones but have minimal side effects,' she said.
Dr Chong said he prefers his patients to apply a natural oil, made purely from botanical oils, directly onto the genitals.
'A clinical study in 2003 showed that 85 per cent of women with low sex drive and 95 per cent of normal women achieved an increase in sexual satisfaction with the oil,' he said.
